6例肠结核术后合并肠外瘘的救治

SALVAGING ENTERIC FISTULAS AFTER EXPLORATORY OPERATION OF INTESTINAL TUBERCULOSIS IN 6 CASES

目的总结肠结核因伴有外科并发症时,需经手术治疗后合并肠外瘘救治的临床经验。方法回顾性分析2000～2008年在我院普通外科收治的出现了急性穿孔、完全性肠梗阻、腹部包块未能排除恶性肿瘤的6例肠结核患者,手术切除主要病变肠段I期吻合术后合并肠外瘘诊治过程。结果本组中5例患者4周～6个月瘘口自然闭合。1例患者因肠外瘘合并感染1周内死亡。结论肠结核应以内科治疗为主,因伴有外科并发症而手术治疗后合并肠外瘘时,亦主张保守治疗。围手术期的充分准备,正确的手术操作,及时有效引流,抗感染同时抗结核化疗,维持内环境平衡和营养支持治疗是保守治疗的关键措施。

Objective To investigate clinical experience in treatment of fistula after the operation on the petients suffered from intestinal tuberculosis with surgical complications. Methods Six intestinal tuberculosis patients were retrospectively analyzed about the process of diagnosis and treatment of enterocutancons fistula after Stage Ⅰ anastomosis, all of whom were with acute perforation, complete intestinal obstruction, or abdominal mass considered as malignant neoplasm, between 2000 and 2008 years in our hospital. Results The fistulas healed spontaneously after 4 weeks to 6 months in 5 cases. One case died of cnteroeutaneous fistula infection in one week. Conclusion Medical therapy is the mainstay in treatment of intestinal tuberculosis, as well as enterocutaneous fistula after the operation. The key measures of conservative treatment are including sufficient perioperative preparation, the corrcct operation, timely and effective drainage, anti -infeetive treatment, antituberculous chemotherapy, keeping balance of body inner environment, and nutritional support.